Regular physical activity is linked to enhanced health and
to reduced risk for all-cause mortality and the development of
many chronic diseases in adults. However, many U.S. adults are
either sedentary or less physically active than recommended.
Children and adolescents are more physically active than adults,
but participation in physical activity declines in adolescence.
School and community programs have the potential to help children
and adolescents establish lifelong, healthy physical activity
patterns.

This report summarizes recommendations for encouraging
physical activity among young people so that they will continue
to engage in physical activity in adulthood and obtain the
benefits of physical activity throughout life. These guidelines
were developed by CDC in collaboration with experts from
universities and from national, federal, and voluntary agencies
and organizations. They are based on an in-depth review of
research, theory, and current practice in physical education,
exercise science, health education, and public health.

The guidelines include recommendations about 10 aspects of
school and community programs to promote lifelong physical
activity among young people: policies that promote enjoyable,
lifelong physical activity; physical and social environments that
encourage and enable physical activity; physical education
curricula and instruction; health education curricula and
instruction; extracurricular physical activity programs that meet
the needs and interests of students; involvement of parents and
guardians in physical activity instruction and programs for young
people; personnel training; health services for children and
adolescents; developmentally appropriate community sports and
recreation programs that are attractive to young people; and
regular evaluation of physical activity instruction, programs,
and facilities.

INTRODUCTION

In recent years the public health benefits of reducing
sedentary lifestyles and promoting physical activity have become
increasingly apparent (1-8). The Surgeon General's report on
physical activity and health emphasizes that regular
participation in moderate physical activity is an essential
component of a healthy lifestyle (1). Although regular physical
activity enhances health and reduces the risk for all-cause
mortality (9-18) and the development of many chronic diseases
among adults (10,12-14,17,19-45), many adults remain sedentary
(46). Although young people are more active than adults are (1),
many young people do not engage in recommended levels of physical
activity (47,48). In addition, physical activity declines
precipitously with age among adolescents (47,48). Comprehensive
school health programs have the potential to slow this
age-related decline in physical activity and help students
establish lifelong, healthy physical activity patterns (49,50).

This report is one in a series of CDC documents that provide
guidelines for school health programs to promote healthy behavior
among children and adolescents (51-53). These physical activity
guidelines address school instructional programs, school
psychosocial and physical environments, and various services
schools provide. Because the physical activity of children and
adolescents is affected by many factors beyond the school
setting, these guidelines also address parental involvement,
community health services, and community sports and recreation
programs for young people.

The guidelines are written for professionals who design and
deliver physical activity programs for young people. At the local
level, teachers and other school personnel, community sports and
recreation program personnel, health service providers, community
leaders, and parents may use the guidelines to promote enjoyable,
lifelong physical activity among children and adolescents.
Policymakers and local, state, and national health and education
agencies and organizations may use them to develop initiatives
that promote physical activity among young people. In addition,
personnel at postsecondary institutions may use these guidelines
to train professionals in education, public health, sports and
recreation, and medicine.

CDC developed these guidelines by reviewing published
research; considering the recommendations in national policy
documents; convening experts in physical activity; and consulting
with national, federal, and voluntary agencies and organizations.
When possible, these guidelines are based on research; however,
many are based on behavioral theory and standards for exemplary
practice in physical education, exercise science, health
education, and public health. More research is needed on the
relationship between physical activity and health among young
people, the relationship between physical activity during
childhood and adolescence and that during adulthood, the
determinants of physical activity among children and adolescents,
and the effectiveness of school and community programs promoting
physical activity among young people.

PHYSICAL ACTIVITY, EXERCISE, AND PHYSICAL FITNESS

Distinctions between physical activity, exercise, and
physical fitness are useful in understanding health research.
Physical activity is "any bodily movement produced by skeletal
muscles that results in energy expenditure.... Exercise is a
subset of physical activity that is planned, structured, and
repetitive" and is done to improve or maintain physical fitness.
Physical fitness is "a set of attributes that are either health-
or skill-related." Health-related fitness includes
cardiorespiratory endurance, muscular strength and endurance,
flexibility, and body composition; skill-related fitness includes
balance, agility, power, reaction time, speed, and coordination
(54).

Specific forms of physical activity and exercise in which
young people might participate include walking, bicycling,
playing actively (i.e., unstructured physical activity),
participating in organized sports, dancing, doing active
household chores, and working at a job that has physical demands.
The places or settings in which young people can engage in
physical activity and exercise include the home, school,
playgrounds, public parks and recreation centers, private clubs
and sports facilities, bicycling and jogging trails, summer
camps, dance centers, and religious facilities.

HEALTH BENEFITS OF PHYSICAL ACTIVITY AND PHYSICAL FITNESS

Regular moderate physical activity results in many health
benefits for adults. For example, it improves cardiorespiratory
endurance, flexibility, and muscular strength and endurance
(1,55). Physical activity may also reduce obesity (56-60),
alleviate depression and anxiety (61-65), and build bone mass
density (66-71). Physically active and physically fit adults are
less likely than sedentary adults to develop the chronic diseases
that cause most of the morbidity and mortality in the United
States: cardiovascular disease (10,12-14,17,19-29,72-77),
hypertension (30-32,78), non-insulin-dependent diabetes mellitus
(33-37), and cancer of the colon (38-45). All-cause mortality
rates are lower among physically active than sedentary people
(9-18).

Although more research is needed on the association between
physical activity and health among young people (79-81), evidence
shows that physical activity results in some health benefits for
children and adolescents. For example, regular physical activity
improves aerobic endurance (82-86) and muscular strength (82,86).
Among healthy young people, physical activity and physical
fitness may favorably affect risk factors for cardiovascular
disease (e.g., body mass index, blood lipid profiles, and resting
blood pressure) (87-100). Regular physical activity among
children and adolescents with chronic disease risk factors is
important (101-105): it decreases blood pressure in adolescents
with borderline hypertension (81), increases physical fitness in
obese children (106,107), and decreases the degree of overweight
among obese children (108-111). Physical activity among
adolescents is consistently related to higher levels of
self-esteem and self-concept and lower levels of anxiety and
stress (112). Although the relationship between physical activity
during youth and the development of osteoporosis later in life is
unclear (113), evidence exists that weight-bearing exercise
increases bone mass density among young people (114,115).

RECOMMENDED PHYSICAL ACTIVITY FOR YOUNG PEOPLE

Increased awareness of the health benefits of physical
activity has led to increased recognition of the need for
initiatives to reduce sedentary lifestyles (1-3,5-8,116-127). The
International Consensus Conference on Physical Activity
Guidelines for Adolescents recommends that "all adolescents...be
physically active daily, or nearly every day, as part of play,
games, sports, work, transportation, recreation, physical
education, or planned exercise, in the context of family, school,
and community activities" and that "adolescents engage in three
or more sessions per week of activities that last 20 minutes or
more at a time and that require moderate to vigorous levels of
exertion" (128).

PREVALENCE OF PHYSICAL ACTIVITY AMONG YOUNG PEOPLE

Although children and adolescents are more physically active
than adults, many young people do not engage in moderate or
vigorous physical activity at least 3 days a week (47,48,129-131).
For example, among high school students, only 52% of girls
and 74% of boys reported that they exercised vigorously on at
least 3 of the previous 7 days (48). Physical activity among both
girls and boys tends to decline steadily during adolescence. For
example, 69% of young people 12-13 years of age but only 38% of
those 18-21 years of age exercised vigorously on at least 3 of
the preceding 7 days (47), and 72% of 9th-grade students but only
55% of 12th-grade students engaged in this level of physical
activity (48).

FACTORS INFLUENCING PHYSICAL ACTIVITY

Demographic, individual, interpersonal, and environmental
factors are associated with physical activity among children and
adolescents. Demographic factors include sex, age, and race or
ethnicity. Girls are less active than boys, older children and
adolescents are less active than younger children and
adolescents, and among girls, blacks are less active than whites
(47,48,132-134).

Individual factors positively associated with physical
activity among young people include confidence in one's ability
to engage in exercise (i.e., self-efficacy) (133,135, 136),
perceptions of physical or sport competence (137-141), having
positive attitudes toward physical education (133,138), and
enjoying physical activity (142,143). Perceiving benefits from
engaging in physical activity or being involved in sports is
positively associated with increased physical activity among
young people (133,137, 138). These perceived benefits include
excitement and having fun; learning and improving skills; staying
in shape; improving appearance; and increasing strength,
endurance, and flexibility (132,137,144-147). Conversely,
perceiving barriers to physical activity, particularly lack of
time, is negatively associated with physical activity among
adolescents (133,137,148). In addition, a person's stage of
change (i.e., readiness to begin being physically active) (149-153)
influences physical activity among adults and may also influence
physical activity among young people.

Interpersonal and environmental factors positively
associated with physical activity among young people include
peers' or friends' support for and participation in physical
activity (133,142,154). Among older children and adolescents,
physical activity is positively associated with that of siblings
(155,156), and research generally reveals a positive relationship
between the physical activity level of parents and that of their
children, particularly adolescents (133,135,141,142,154,156-163).
Parental support for physical activity is correlated with active
lifestyles among adolescents (133,141, 154,157). Physical
activity among young people is also positively correlated with
having access to convenient play spaces (133,160), sports
equipment (142,157), and transportation to sports or fitness
programs (158).

OBJECTIVES FOR PHYSICAL ACTIVITY AMONG YOUNG PEOPLE

The following national health promotion and disease
prevention objectives for the year 2000 are related to physical
activity and fitness among children and adolescents (164).

1.2 Reduce overweight to a prevalence of less than or equal to

20% among people aged greater than or equal to 20 years
and less
than or equal to 15% among adolescents aged 12-19 years.
1.3 Increase to greater than or equal to 30% the proportion of

people aged greater than or equal to 6 years who engage
regularly, preferably daily, in light to moderate physical
activity for greater than or equal to 30 minutes per day.
1.4 Increase to greater than or equal to 20% the proportion of

people aged greater than or equal to 18 years and to
greater
than or equal to 75% the proportion of children and
adolescents
aged 6-17 years who engage in vigorous physical activity
that
promotes the development and maintenance of
cardiorespiratory
fitness greater than or equal to 3 days per week for
greater
than or equal to 20 minutes per occasion.
1.5 Reduce to less than or equal to 15% the proportion of
people

aged greater than or equal to 6 years who engage in no
leisure-time physical activity.
1.6 Increase to greater than or equal to 40% the proportion of

people aged greater than or equal to 6 years who regularly
perform physical activities that enhance and maintain
muscular
strength, muscular endurance, and flexibility.
1.7 Increase to greater than or equal to 50% the proportion of

overweight people aged greater than or equal to 12 years
who
have adopted sound dietary practices combined with regular
physical activity to attain an appropriate body weight.
1.8 Increase to greater than or equal to 50% the proportion of

children and adolescents in 1st through 12th grade who
participate in daily school physical education.
1.9 Increase to greater than or equal to 50% the proportion of

school physical education class time that students spend
being
physically active, preferably engaged in lifetime physical
activities.
1.11 Increase community availability and accessibility of

physical activity and fitness facilities.
1.12 Increase to greater than or equal to 50% the proportion of

primary care providers who routinely assess and counsel
their
patients regarding the frequency, duration, type, and
intensity of each patient's physical activity practices.

RATIONALE FOR SCHOOL AND COMMUNITY EFFORTS TO PROMOTE PHYSICAL
ACTIVITY AMONG YOUNG PEOPLE

Schools and communities should promote physical activity
among children and adolescents because many young people already
have risk factors for chronic diseases associated with adult
morbidity and mortality (165). For example, the prevalence of
overweight is at an all-time high among children and adolescents
(166). In addition, physical activity has a beneficial effect on
the physical and mental health of young people
(81-100,106-112,114,115).

People begin to acquire and establish patterns of
health-related behaviors during childhood and adolescence (167);
thus, young people should be encouraged to engage in physical
activity. However, many children are less physically active than
recommended (47,48,129-131). Physical activity declines during
adolescence (47,48), and enrollment in daily physical education
has decreased (48,168).

Schools and communities have the potential to improve the
health of young people by providing instruction, programs, and
services that promote enjoyable, lifelong physical activity
(116-121,124,125). Schools are an efficient vehicle for providing
physical activity instruction and programs because they reach
most children and adolescents (49,125,169). Communities are
essential because most physical activity among young people
occurs outside the school setting (129,170).

Schools and communities should coordinate their efforts to
make the best use of their resources in promoting physical
activity among young people (49,50). School personnel, students,
families, community organizations, and businesses should
collaborate to develop, implement, and evaluate physical activity
instruction and programs for young people. One way to achieve
this collaboration is to form a coalition (171). National, state,
and local resources that might be useful in promoting physical
activity among young people are available to schools and
community groups (Appendix A).

Within the school, efforts to promote physical activity
among students should be part of a coordinated, comprehensive
school health program, which is "an integrated set of planned,
sequential, and school-affiliated strategies, activities, and
services designed to promote the optimal physical, emotional,
social, and educational development of students. The program
involves and is supportive of families and is determined by the
local community based on community needs, resources, standards,
and requirements. It is coordinated by a multidisciplinary team
and accountable to the community for program quality and
effectiveness" (172). This coordinated program should include
health education; physical education; health services; school
counseling and social services; nutrition services; the
psychosocial and biophysical environment; faculty and staff
health promotion; and integrated efforts of schools, families,
and communities (173). These programs have the potential to
improve both the health and the educational prospects of students
(49,50).

Some school health programs have implemented educational and
environmental interventions to promote physical activity among
students (132,174-187). These programs have been effective in
enhancing students' physical activity-related knowledge
(174,175,183), attitudes (187), and behavior (132,186) and their
physical fitness (183). Programs that seem to be most effective
focus on social factors that influence physical activity (e.g.,
peers' support for physical activity (188).

RECOMMENDATIONS FOR SCHOOL AND COMMUNITY PROGRAMS PROMOTING
PHYSICAL ACTIVITY AMONG YOUNG PEOPLE

Listed below are 10 broad recommendations for school and
community programs to promote physical activity among young
people. Following this list, each recommendation is described in
detail.

Policy: Establish policies that promote enjoyable, lifelong

physical activity among young people.

2. Environment: Provide physical and social environments that
encourage and enable safe and enjoyable physical activity.

6. Parental involvement: Include parents and guardians in
physical activity instruction and in extracurricular and
community physical activity programs, and encourage them to
support their children's participation in enjoyable physical
activities.

7. Personnel training: Provide training for education,
coaching,
recreation, health-care, and other school and community personnel
that imparts the knowledge and skills needed to effectively
promote enjoyable, lifelong physical activity among young people.

8. Health services: Assess physical activity patterns among
young
people, counsel them about physical activity, refer them to
appropriate programs, and advocate for physical activity
instruction and programs for young people.

9. Community programs: Provide a range of developmentally
appropriate community sports and recreation programs that are
attractive to all young people.

10. Evaluation: Regularly evaluate school and community
physical
activity instruction, programs, and facilities.

Policies provide formal and informal rules that guide
schools and communities in planning, implementing, and evaluating
physical activity programs for young people. School and community
policies related to physical activity should comply with state
and local laws and with recommendations and standards provided by
national, state, and local agencies and organizations. These
policies should be included in a written document that
incorporates input from administrators, teachers, coaches,
athletic trainers, parents, students, health-care providers,
public health professionals, and other school and community
personnel and should address the following requirements.

Require comprehensive, daily physical education for students in
kindergarten through grade 12.

Physical education instruction can increase students'
knowledge (183), physical activity in physical education class
(177,179,189), and physical fitness (183,190-195). Daily physical
education from kindergarten through 12th grade is recommended by
the American Heart Association (118) and the National Association
for Sport and Physical Education (196) and is also a national
health objective for the year 2000 (164). The minimum amount of
physical education required for students is usually set by state
law. Although most states (94%) and school districts (95%)
require some physical education (173,197), only one state
requires it daily from kindergarten through 12th grade. Less than
two thirds (60%) of high school students are enrolled in physical
education classes, and only 25% take physical education daily
(48). Enrollment in both physical education (9th grade, 81%; 12th
grade, 42%) and daily physical education (9th grade, 41%; 12th
grade, 13%) declines at higher grades, and enrollment in daily
physical education and active time in physical education classes
decreased from 1991 to 1995 among high school students (48).
Further, 30% of schools exempt students from physical education
if the students participate in band, chorus, cheerleading, or
interscholastic sports (197). Substitution of these programs for
physical education reduces students' opportunities to develop
knowledge, attitudes, motor skills, behavioral skills, and
confidence related to physical activity (196,198).

Require comprehensive health education for students in
kindergarten through grade 12.

Comprehensive health education, which includes instruction
on physical activity topics, can complement the instruction
students receive in comprehensive physical education (179).
Health education may improve students' health knowledge,
attitudes, and behaviors (199). Many educational organizations
recommend that students receive planned and sequential health
education from kindergarten through 12th grade (200-203), and
such education is a national health objective for the year 2000
(164). Although many states (90%) and school districts (91%)
require that schools offer health education, fewer school
districts require that a separate course be devoted to health
topics (elementary school, 19%; middle school, 44%; senior high
school, 66%) (204). Administrators of public schools and parents
of adolescents in public schools believe that these students
should be taught more health information and skills (205).

Require that adequate resources, including budget and facilities,
be committed for physical activity instruction and programs.

The National Association for Sport and Physical Education
and the Joint Committee for National Health Education Standards
note that adequate budget and facilities are necessary for
physical education, health education, extracurricular physical
activities, and community sports and recreation programs to be
successful (198,206-208). However, these programs rarely have
sufficient resources (168,209). Schools and communities should be
vigilant in ensuring that physical education, health education,
and physical activity programs have sufficient financial and
facility resources to ensure safe participation by young people
(198,206-208). Schools should have policies that ensure that
teacher-to-student ratios in physical education are comparable to
those in other subjects (198,206,207,210) and that physical
education spaces and facilities are not usurped for other events.
Schools should have policies requiring that physical education
classes be scheduled so that students in each class are of
similar physical maturity and grade level (198,206,207).

Require the hiring of physical education specialists to teach
physical education in kindergarten through grade 12, elementary
school teachers trained to teach health education, health
education specialists to teach health education in middle and
senior high schools, and qualified people to direct school and
community physical activity programs and to coach young people in
sports and recreation programs.

Planning, implementing, and evaluating physical activity
instruction and programs require specially trained personnel
(125,198,206-208,211). Physical education specialists teach
longer lessons, spend more time on developing skills, impart more
knowledge, and provide more moderate and vigorous physical
activity than do classroom teachers (189,212). Schools should
have policies requiring that physical education specialists teach
physical education in kindergarten through grade 12, elementary
school teachers trained to teach health education do so in
elementary schools, health education specialists teach health
education in middle and senior high schools, and qualified people
direct school and community physical activity programs and coach
young people in sports and recreation programs (198,206-208,211).

Some states have established minimum standards for teachers.
Eighty-four percent of states require physical education
certification for secondary school physical education teachers,
and 16% require such certification for elementary school physical
education teachers (197). Only 69% of states require health
education certification for secondary school health education
teachers (204). These data indicate the need for a greater
commitment to hiring professionally trained physical education
specialists and health education specialists for our nation's
schools.

Some states have established minimum standards for athletic
coaches. Both schools and communities should have policies that
require employing people who have the coaching competency
appropriate to participants' developmental and skill levels
(213). Coaches who work with beginning athletes should meet at
least the Level I, if not Level II, coaching competencies
identified by the National Association for Sport and Physical
Education (213). Entry-level interscholastic coaches and master
coaches should achieve at least Level III and Level IV coaching
competencies, respectively (213).

Require that physical activity instruction and programs meet the
needs and interests of all students.

All students, irrespective of their sex, race/ethnicity,
health status, or physical and cognitive ability or disability
should have access to physical education, health education,
extracurricular physical activity programs, and community sports
and recreation programs that meet their needs and interests
(214,215). In addition, physical activity programs that
overemphasize a limited set of team sports and underemphasize
noncompetitive, lifetime fitness and recreational activities
(e.g., walking or bicycling) could exclude or be unattractive to
potential participants (131,216).

Adolescents' interests and participation in physical
activity differ by sex (47, 48,217). For example, compared with
boys, girls engage in less physical activity (47,48), are less
likely to participate in team sports (47,48,218), and are more
likely to participate in aerobics or dance (47). Girls and boys
also perceive different benefits of physical activity
(132,137,145,147); for example, boys more often cite competition
and girls more often cite weight management as a reason for
engaging in physical activity (132,137). Because boys are more
likely than girls to have higher perceptions of self-efficacy
(136) and physical competence (137,219), physical activity
programs serving girls should provide instruction and experiences
that increase girls' confidence in participating in physical
activity, opportunities for them to participate in physical
activities, and social environments that support their
involvement in a range of physical activities. Adolescents'
participation in physical activity also differs by race and
ethnicity (47,48).

Children and adolescents who are obese or who have physical
or cognitive disabilities, chronic health conditions (e.g.,
diabetes, heart disease, or asthma), or low levels of fitness
need instruction and programs in which they can develop motor
skills, improve fitness, and experience enjoyment and success
(3,124,143,164,220). Young people who have these disabilities or
health concerns are often overtly or unintentionally discouraged
from engaging in regular physical activity even though they may
be in particular need of it (220,221). For example, 59% of high
schools allow students who have physical disabilities to be
exempt from physical education courses (197). Schools should be
required to provide modified physical education and health
education for these students (221,222). By modifying physical
education, health education, extracurricular physical activities,
and community sports and recreation programs, schools and
communities can help these young people acquire the physical,
mental, and social benefits of physical activity.

Physical education, health education, extracurricular
physical activity programs, and community sports and recreation
programs can also provide opportunities for multicultural
experiences (e.g., American Indian and African dance). These
experiences can meet children's and adolescents' interests and
foster their awareness and appreciation of different physical
activities enjoyed by different cultural groups (223).

The physical and social environments of children and
adolescents should encourage and enable their participation in
safe and enjoyable physical activities. These environments are
described by the following guidelines.

Provide access to safe spaces and facilities for physical
activity in the school and the community.

School spaces and facilities should be available to young
people before, during, and after the school day, on weekends, and
during summer and other vacations. These spaces and facilities
should also be readily available to community agencies and
organizations offering physical activity programs
(3,118,119,124,127,198,200, 206,207,224).

National health objective 1.11 calls for increased
availability of facilities for physical activity (e.g., hiking,
bicycling, and fitness trails; public swimming pools; and parks
and open spaces for recreation) (164). Community coalitions
should coordinate the availability of these open spaces and
facilities. Some communities may need to build new facilities,
whereas others may need only to coordinate existing community
spaces and facilities. The needs of all children and adolescents,
particularly those who have disabilities, should be incorporated
into the building of new facilities and the coordination of
existing ones.

Schools and communities should ensure that spaces and
facilities meet or exceed recommended safety standards for
design, installation, and maintenance (206,207, 225,226). For
example, playgrounds should have cool water and adequate shade
for play and rest (227). Young people also need places that are
free from violence and free from exposure to environmental
hazards (e.g., fumes from incinerators or motor vehicles). Spaces
and facilities for physical activity should be regularly
inspected, and hazardous conditions should be immediately
corrected (206,207,228).

Minimizing physical activity-related injuries and illnesses
among young people is the joint responsibility of teachers,
administrators, coaches, athletic trainers, other school and
community personnel, parents, and young people (226). Preventing
injuries and illness includes having appropriate adult
supervision, ensuring compliance with safety rules and the use of
protective clothing and equipment, and avoiding the effects of
extreme weather conditions. Explicit safety rules should be
taught to, and followed by, young people in physical education,
health education, extracurricular physical activity programs, and
community sports and recreation programs (164,206, 229-231).
Adult supervisors should consistently reinforce safety rules
(231).

Adult supervisors should be aware of the potential for
physical activity-related injuries and illnesses among young
people so that the risks for and consequences of these injuries
and illnesses can be minimized (228,229). These adults should
receive medical information relevant to each student's
participation in physical activity (e.g., whether the child has
asthma), be able to provide first aid and cardiopulmonary
resuscitation, and practice precautions to prevent the spread of
bloodborne pathogens (e.g., the human immunodeficiency virus)
(198,207). Written policies on providing first aid and reporting
injuries and illnesses to parents and to appropriate school and
community authorities should be established and followed
(198,207). Adult supervisors can take the following steps to
avoid injuries and illnesses during structured physical activity
for young people: require physical assessment before
participation, provide developmentally appropriate activities,
ensure proper conditioning, provide instruction on the
biomechanics of specific motor skills, appropriately match
participants according to size and ability, adapt rules to the
skill level of young people and the protective equipment
available, avoid excesses in training, modify rules to eliminate
unsafe practices, and ensure that injuries are healed before
further participation (198,207,227,228).

Children and adolescents should be provided with, and
required to use, protective clothing and equipment appropriate to
the type of physical activity and the environment
(164,198,206,207,227-229,231). Protective clothing and equipment
includes footwear appropriate for the specific activity; helmets
for bicycling; helmets, face masks, mouth guards, and protective
pads for football and ice hockey; and reflective clothing for
walking and running. Protective gear and athletic equipment
should be frequently inspected, and they should be replaced if
worn, damaged, or outdated.

Exposure to the sun can be minimized by use of protective
hats, clothing, and sunscreen; avoidance of midday sun exposure;
and use of shaded spaces or indoor facilities (164,227,232).
Heat-related illnesses can be prevented by ensuring that children
and adolescents frequently drink cool water, have adequate rest
and shade, play during cool times of the day, and are supervised
by people trained to recognize the early signs of heat exhaustion
and heat stroke (227). Cold-related injuries can be avoided by
ensuring that young people wear multilayered clothing for outside
play and exercise, increasing the intensity of outdoor
activities, using indoor facilities during extremely cold
weather, ensuring proper water temperature for aquatic
activities, and providing supervision by persons trained to
recognize the early signs of frostbite and hypothermia (227).
Measures should be taken to avoid health problems associated with
poor air quality (e.g., reduce the intensity of physical activity
or hold physical education classes or programs indoors).

Teachers, parents, coaches, athletic trainers, and
health-care providers should promote a range of healthy
behaviors. These adults should encourage young people to abstain
from tobacco, alcohol, and other drugs; to maintain a healthy
diet; and to practice healthy weight management techniques (227).
Adult supervisors should be aware of the signs and symptoms of
eating disorders and take steps to prevent eating disorders among
young people (227).

Provide time within the school day for unstructured physical
activity.

During the school day, opportunities for physical activity
exist within physical education classes, during recess, and
immediately before and after school. For example, students in
grades one through four have an average recess period of 30
minutes (233). School personnel should encourage students to be
physically active during these times. The use of time during the
school day for unstructured physical activity should complement
rather than substitute for the physical activity and instruction
children receive in physical education classes.

Discourage the use or withholding of physical activity as
punishment.

Teachers, coaches, and other school and community personnel
should not force participation in or withhold opportunities for
physical activity as punishment. Using physical activity as a
punishment risks creating negative associations with physical
activity in the minds of young people. Withholding physical
activity deprives students of health benefits important to their
well-being.

Provide health promotion programs for school faculty and staff.

Enabling school personnel to participate in physical
activity and other healthy behaviors should help them serve as
role models for students. School-based health promotion programs
have been effective in improving teachers' participation in
vigorous exercise, which in turn has improved their physical
fitness, body composition, blood pressure, general well-being,
and ability to handle job stress (234,235). In addition,
participants in school-based health promotion programs may be
less likely than nonparticipants to be absent from work (235).

Physical education curricula and instruction are vital parts
of a comprehensive school health program. One of the main goals
of these curricula should be to help students develop an active
lifestyle that will persist into and throughout adulthood
(3,174,180,236,237).
Provide planned and sequential physical education curricula from
kindergarten through grade 12 that promote enjoyable, lifelong
physical activity.

School physical education curricula are often mandated by
state laws or regulations. Many states (76%) and school districts
(89%) have written goals, objectives, or outcomes for physical
education (CDC, unpublished data), and only 26% of states require
a senior high school physical education course promoting physical
activities that can be enjoyed throughout life (197). Planned and
sequential physical education curricula should emphasize
knowledge about the benefits of physical activity and the
recommended amounts and types of physical activity needed to
promote health (3,116-118,124,164). Physical education should
help students develop the attitudes, motor skills, behavioral
skills, and confidence they need to engage in lifelong physical
activity (116-118,122,125,164,237). Physical education should
emphasize skills for lifetime physical activities (e.g., dance,
strength training, jogging, swimming, bicycling, cross-country
skiing, walking, and hiking) rather than those for competitive
sports (116-118,164,197,237-239).

If physical fitness testing is used, it should be integrated
into the curriculum and emphasize health-related components of
physical fitness (e.g., cardiorespiratory endurance, muscular
strength and endurance, flexibility, and body composition). The
tests should be administered only after students are well
oriented to the testing procedures. Testing should be a mechanism
for teaching students how to apply behavioral skills (e.g.,
self-assessment, goal setting, and self-monitoring) to physical
fitness development and for providing feedback to students and
parents about students' physical fitness. The results of physical
fitness testing should not be used to assign report card grades
(193,240,241). Also, test results should not be used to assess
program effectiveness; the validity of these measurements may be
unreliable, and physical fitness and improvements in physical
fitness are influenced by factors (e.g., physical maturation,
body size, and body composition) beyond the control of teachers
and students (193,240,241).

Use physical education curricula consistent with the national
standards for physical education.

The national standards for physical education (211) describe
what students should know and be able to do as a result of
physical education. A student educated about physical activity
"has learned skills necessary to perform a variety of physical
activities, is physically fit, does participate regularly in
physical activity, knows the implications of and the benefits
from involvement in physical activities, {and} values physical
activity and its contribution to a healthful lifestyle" (196).
The national stan-dards emphasize the development of movement
competency and proficiency, use of cognitive information to
enhance motor skill acquisition and performance, establishment of
regular participation in physical activity, achievement of
health-enhancing physical fitness, development of responsible
personal and social behavior, understanding of and respect for
individual differences, and awareness of values and benefits of
physical activity participation (211). These standards provide a
framework that should be used to design, implement, and evaluate
physical education curricula that promote enjoyable, lifelong
physical activity.

Enjoyable physical education experiences are believed to be
essential in promoting physical activity among children and
adolescents (3,124,125). Physical education experiences that are
enjoyable and actively involve students in learning may help
foster positive attitudes toward and encourage participation in
physical education and physical activity (133,138). Active
learning strategies that involve the student in learning physical
activity concepts, motor skills, and behavioral skills include
brainstorming, cooperative groups, simulation, and situation
analysis.

Knowledge of physical activity is viewed as an essential
component of physical education curricula (117,118,124,125,164).
Related concepts include the physical, social, and mental health
benefits of physical activity; the components of health-related
fitness; principles of exercise; injury prevention; precautions
for preventing the spread of bloodborne pathogens; nutrition and
weight management; social influences on physical activity; and
the development of safe and effective individualized physical
activity programs. For both young people and adults, knowledge
about how to be physically active may be a more important
influence on physical activity than is knowledge about why to be
active (237,242).

Positive attitudes toward physical activity may affect young
people's involvement in physical activity (116-118,124,125,164).
Positive attitudes include perceptions that physical activity is
important and that it is fun. Ways to generate positive attitudes
include providing students with enjoyable physical education
experiences that meet their needs and interests, emphasizing the
many benefits of physical activity, supporting students who are
physically active, and using active learning strategies.

Develop students' mastery of and confidence in motor and
behavioral skills for participating in physical activity.

Physical education should help students master (243-245) and
gain confidence in (3,125,219,242) motor and behavioral skills
used in physical activity. Students should become competent in
many motor skills and proficient in a few to use in lifelong
physical activities (117,118,122,124,164,211). Elementary school
students should develop basic motor skills that allow
participation in a variety of physical activities, and older
students should become competent in a select number of lifetime
physical activities they enjoy and succeed in. Students' mastery
of and confidence in motor skills occurs when these skills are
broken down into components and the tasks are ordered from easy
to hard (246). In addition, students need opportunities to
observe others performing the skills and to receive
encouragement, feedback, and repeated opportunities for practice
during physical education class (246).

Behavioral skills (e.g., self-assessment, self-monitoring,
decision making, goal setting, and communication) may help
students establish and maintain regular involvement in physical
activity. Active student involvement and social learning
experiences that focus on building confidence may increase the
likelihood that children and adolescents will enjoy and succeed
in physical education and physical activity (246).

For physical education to make a meaningful and consistent
contribution to the recommended amount of young people's physical
activity, students at every grade level should take physical
education classes that meet daily and should be physically active
for a large percentage of class time (3,125,164,247). National
health objective 1.9 calls for students to be physically active
for at least 50% of physical education class time (164), but many
schools do not meet this objective (212,248-251), and the
percentage of time students spend in moderate or vigorous
physical activity during physical education classes has decreased
over the past few years (48).

Promote participation in enjoyable physical activity in the
school, community, and home.

Physical education teachers should encourage students to be
active before, during, and after the school day. Physical
education teachers can also refer students to community physical
sports and recreation programs available in their community (3)
and promote participation in physical activity at home by
assigning homework that students can do on their own or with
family members (122).

Health education can effectively promote students'
health-related knowledge, attitudes, and behaviors (199,252,253).
The major contribution of health education in promoting physical
activity among students should be to help them develop the
knowledge, attitudes, and behavioral skills they need to
establish and maintain a physically active lifestyle
(208,209,254).

Many states (65%) and school districts (82%) require that
physical activity and physical fitness topics be part of a
required course in health education (204). Planned and sequential
health education curricula, like physical education curricula,
should draw on social cognitive theory (188) and emphasize
physical activity as a component of a healthy lifestyle.
Use health education curricula consistent with the national
standards for health education.

The national standards for health education developed by the
Joint Committee for National Health Education Standards (208)
describe what health-literate students should know and be able to
do as a result of school health education. Health literacy is
"the capacity of individuals to obtain, interpret, and understand
basic health information and services and the competence to use
such information and services in ways which enhance health"
(208). The standards specify that, as a result of health
education, students should be able to comprehend basic health
concepts; access valid health information and health-promoting
products and services; practice health-enhancing behaviors;
analyze the influence of culture and other factors on health; use
interpersonal communication skills to enhance health; use
goal-setting and decision-making skills to enhance health; and
advocate for personal, family, and community health. These
standards emphasize the development of students' skills and can
be used as the basis for health education curricula.

Promote collaboration among physical education, health education,
and classroom teachers as well as teachers in related disciplines
who plan and implement physical activity instruction.

Physical education and health education teachers in about
one third of middle and senior high schools collaborate on
activities or projects (197,204). Collaboration allows
coordinated physical activity instruction and should enable
teachers to provide range and depth of physical activity-related
content and skills. For example, health education and physical
education teachers can collaborate to reinforce the link between
sound dietary practices and regular physical activity for weight
management. Collaboration also allows teachers to highlight the
influence of other behaviors on the capacity to engage in
physical activity (e.g., using alcohol or other drugs) or
behaviors that interact with physical activity to reduce the risk
of developing chronic diseases (e.g., not using tobacco).

Use active learning strategies to emphasize enjoyable
participation in physical activity in the school, community, and
home.

Health education instruction should include the use of
active learning strategies. Such strategies may encourage
students' active involvement in learning and help them develop
the concepts, attitudes, and behavioral skills they need to
engage in physical activity (209,254). Additionally, health
education teachers should encourage students to adopt healthy
behaviors (e.g., physical activity) in the school, community, and
home.

Health education curricula should provide information about
physical activity concepts (3). These concepts should include the
physical, social, and mental health benefits of physical
activity; the components of health-related fitness; principles of
exercise; injury prevention and first aid; precautions for
preventing the spread of bloodborne pathogens; nutrition,
physical activity, and weight management; social influences on
physical activity; and the development of safe and effective
individualized physical activity programs.

Health instruction should also generate positive attitudes
toward healthy behaviors. These positive attitudes include
perceptions that it is important and fun to participate in
physical activity. Ways to foster positive attitudes include
emphasizing the multiple benefits of physical activity,
supporting children and adolescents who are physically active,
and using active learning strategies.

Develop students' mastery of and confidence in the
behavioral skills needed to adopt and maintain a healthy
lifestyle that includes regular physical activity.

Children and adolescents should develop behavioral skills
that may enable them to adopt healthy behaviors (116,164).
Certain skills (e.g., self-assessment, self-monitoring, decision
making, goal setting, identifying and managing barriers,
self-regulation, reinforcement, communication, and advocacy) may
help students adopt and maintain a healthy lifestyle that
includes regular physical activity. Active learning strategies
give students opportunities to practice, master, and develop
confidence in these skills (209,254).

Extracurricular activities are any activities offered by
schools outside of formal classes. Interscholastic athletics,
intramural sports, and sports and recreation clubs are believed
to contribute to the physical and social development of young
people (196), and schools should extend these benefits to the
greatest possible number of students. These activities can help
meet the goals of comprehensive school health programs by
providing students with opportunities to engage in physical
activity and to further develop the knowledge, attitudes, motor
skills, behavioral skills, and confidence needed to adopt and
maintain physically active lifestyles.

Provide a diversity of developmentally appropriate
competitive and noncompetitive physical activity programs for all
students.

Interscholastic athletic programs are typically limited to
the secondary school level and usually consist of a few highly
competitive team sports. Intramural sports programs are not
common but, where they are offered, usually emphasize competitive
team sports. Such programs usually underserve students who are
less skilled, less physically fit, or not attracted to
competitive sports (145,255,256). One reason that participation
in sports declines steadily during late childhood and adolescence
is that undue emphasis is placed on competition (145).

After the needs and interests of all students are assessed,
interscholastic, intramural, and club programs should be modified
and expanded to offer a range of competitive and noncompetitive
activities. For example, noncompetitive lifetime physical
activities include walking, running, swimming, and bicycling
(118).

Link students to community physical activity programs, and use
community resources to support extracurricular physical activity
programs.

Schools should work with community organizations to enhance
the appropriate use of out-of-school time among children and
adolescents (224) and to develop effective systems for referring
young people from schools to community agencies and organizations
that can provide needed services. To help students learn about
community resources, schools can sponsor information fairs that
represent community groups, physical education and health
education teachers can provide infor- mation about community
resources as part of the curricula (3), and community-based
program personnel can be speakers or demonstration lecturers in
school classes.

Frequently schools have the facilities but lack the
personnel to deliver extracurricular physical activity programs.
Community resources can expand existing school programs by
providing intramural and club activities on school grounds. For
example, community agencies and organizations can use school
facilities for after-school physical fitness programs for
children and adolescents, weight management programs for
overweight or obese young people, and sports and recreation
programs for young people with disabilities or chronic health
conditions.

Recommendation 6. Parental involvement: Include parents and
guardians in physical activity instruction and in extracurricular
and community physical activity programs, and encourage them to
support their children's participation in enjoyable physical
activities.

Parental involvement in children's physical activity
instruction and programs is key to the development of a
psychosocial environment that promotes physical activity among
young people (116,117,208,231,257,258). Involvement in these
programs provides parents opportunities to be partners in
developing their children's physical activity-related knowledge,
attitudes, motor skills, behavioral skills, confidence, and
behavior. Thus, teachers, coaches, and other school and community
personnel should encourage and enable parental involvement. For
example, teachers can assign homework to students that must be
done with their parents and can provide flyers designed for
parents that contain information and strategies for promoting
physical activity within the family (259). Parents can also join
school health advisory councils, booster clubs, and
parent-teacher organizations (209,259). Parents who have been
trained by professionals can also serve as volunteer coaches for
or leaders of extracurricular physical activity programs and
community sports and recreation programs.

Encourage parents to advocate for quality physical activity
instruction and programs for their children.

Parents may be able to influence the quality and quantity of
physical activity available to their children by advocating for
comprehensive, daily physical education in schools and for school
and community physical activity programs that promote lifelong
physical activity among young people (164). Parents should also
advocate for safe spaces and facilities that provide their
children opportunities to engage in a range of physical
activities (164,257).

Encourage parents to support their children's participation in
appropriate, enjoyable physical activities.

Parents should ensure that their children participate in
physical education classes, extracurricular physical activity
programs, and community sports and recreation programs in which
the children will experience enjoyment and success (145). Parents
should learn what their children want from extracurricular and
community physical activity programs and then help select
appropriate activities (145). Fun and skill development, rather
than winning, are the primary reasons most young people
participate in physical activity and sports programs (145,255).
Parents should help their children gain access to toys and
equipment for physical activity and transportation to activity
sites (145).

Encourage parents to be physically active role models and to plan
and participate in family activities that include physical
activity.

Parental support is a determinant of physical activity among
children and adolescents (133,141,154,157), and parents'
attitudes toward physical activity may influence children's
involvement in physical activity (260). Parents and guardians
should try to be role models for physical activity behavior and
should plan and participate in family activities (e.g., going to
the community swimming pool or using the community trails for
bicycling or walking) (3,116,117,164,231,239,257,258).

Because peers and friends influence children's physical
activity behavior (133, 142,154), parents can encourage their
children to be active with their friends. Children's
participation in sedentary activities (e.g., watching television
or playing video games) should be monitored and replaced with
physical activity (164,242), and parents should encourage their
children to play outside in safe places and in supervised
playgrounds and parks (231,261).

Recommendation 7. Personnel training: Provide training for
education, coaching, recreation, health-care, and other school
and community personnel that imparts the knowledge and skills
needed to effectively promote enjoyable, lifelong physical
activity among young people.

The lack of trained personnel is a barrier to implementing
safe, organized, and effective physical activity instruction and
programs for young people. National, state, and local education
and health agencies; institutions of higher education; and
national and state professional organizations should collaborate
to provide teachers, coaches, administrators, and other school
personnel pre-service and in-service training in promoting
enjoyable, lifelong physical activity among young people
(116,121,124,164,247,262). Instructor training has proven to be
efficacious; for example, physical education specialists teach
longer and higher quality lessons (189,212), and teacher training
is important in successful implementation of innovative health
education curricula (263,264). Institutions of higher education
should use national guidelines such as those for athletic coaches
(213), entry-level physical education teachers (265), entry-level
health education teachers (266), and elementary school classroom
teachers (267) to plan, implement, and evaluate professional
preparation programs for school personnel. In addition,
physicians, school nurses, and others who provide health services
to young people need pre-service training in promoting physical
activity and providing physical activity assessment, counseling,
and referral (116, 121,124,164).

Although many states and school districts provide in-service
training on physical education topics (72% and 50%, respectively)
(197), all states and school districts need to do so. School
personnel often want more training than they receive. For
example, more than one third of lead physical education teachers
want additional training in developing individualized fitness
programs, increasing students' physical activity inside and
outside of class, and involving families in physical activity
(197).

Train teachers to deliver physical education that provides a
substantial percentage of each student's recommended weekly
amount of physical activity.

The proportion of physical education class time spent on
moderate or vigorous physical activity is insufficient to meet
national health objective 1.9 (212,248-251). In-service teacher
training that focuses on increasing the amount of class time
spent on moderate or vigorous physical activity is effective in
increasing students' physical activity during physical education
classes (176,177,179,189). Although 52% of states have offered
training to physical education teachers on increasing students'
physical activity during class, only 15% of school districts have
provided this training (197). National, state, and local
education and health agencies; institutions of higher education;
and national and state professional organizations should augment
efforts to provide this training to teachers.

Physical education and health education teachers should
observe experienced teachers using active learning strategies,
have hands-on practice in using these strategies, and receive
feedback (268). Such training should increase teachers' use of
these strategies.

Train school and community personnel how to create psychosocial
environments that enable young people to enjoy physical activity
instruction and programs.

Pre-service and in-service training should help teachers,
coaches, and other school and community personnel plan and
implement physical education as well as extracurricular and
community physical activity programs that meet a range of
students' needs and interests. Training should also encourage
these school and community personnel to place less emphasis on
competition and more emphasis on students' having fun and
developing skills.

Train school and community personnel how to involve parents and
the community in physical activity instruction and programs.

Few teachers, coaches, and other school personnel have been
trained to involve families and the community in physical
activity instruction and programs (197). Instruction on
communication skills for interacting with parents and the
community as well as strategies for obtaining adults' support for
physical activity instruction and programs is beneficial
(124,259). Teachers should have the knowledge, skills, and
materials for creating fact sheets for parents and assigning
physical education and health education homework for students to
complete with their families (259).

Train volunteers who coach sports and recreation programs for
young people.

Volunteer coaches who work with beginning athletes in
schools and communities should have the Level I coaching
competency delineated by the National Association for Sport and
Physical Education (213). Like professional coaches, volunteer
coaches should receive professional training on how to provide
experiences for young people that emphasize fun, skill
development, confidence-building, and self-knowledge (145) and
injury prevention, first aid, cardiopulmonary resuscitation,
precautions against contamination by bloodborne pathogens, and
promotion of other healthy behaviors (e.g., dietary behavior).

Recommendation 8. Health services: Assess physical activity
patterns among young people, counsel them about physical
activity, refer them to appropriate programs, and advocate for
physical activity instruction and programs for young people.

Physicians, school nurses, and other people who provide
health services to young people have a key role in promoting
healthy behaviors. Health-care providers are important in
promoting physical activity, especially among children and
adolescents who have physical and cognitive disabilities or
chronic health conditions.

Regularly assess the physical activity patterns of young people,
reinforce physical activity among active young people, counsel
inactive young people about physical activity, and refer young
people to appropriate physical activity programs.

As a routine part of care, health-care providers should
assess the physical activity of their young patients
(117,164,230,231,258,269). Young people and their families should
be counseled about the importance of physical activity and be
provided information that enable young people to initiate and
maintain regular, safe, and enjoyable participation in physical
activity (3,164,230,231,239,258). Children and adolescents who
are already active should be encouraged to continue their
physical activity. Health-care providers should work with
inactive young people and their families to develop exercise
prescriptions and should refer these young people to school and
community physical activity programs appropriate to the youths'
needs and interests (117,258). Children with chronic diseases,
risk factors for chronic diseases, and physical and cognitive
disabilities have special physical activity needs (257,269).
Obese children and adolescents, for example, should be referred
to a physical activity and nutrition program for overweight young
people.

Advocate for school and community physical activity instruction
and programs that meet the needs of young people.

To help create physical and social environments that
encourage physical activity, health-care providers should
advocate for physical education curricula, extracurricular
activities, and community sports and recreation programs that
emphasize lifetime physical activities and that enable
participation in safe, enjoyable physical activities
(116,239,257,258). Physicians, school nurses, and other
health-care professionals can support physical activity among
children and adolescents by becoming involved in school and
community physical activity initiatives. Within schools, many
nurses are already involved in joint activities or projects with
physical education teachers and health education teachers (270).
Physicians can volunteer to serve as advisors to schools and
other community organizations that provide physical activity
instruction and programs to young people (269). Health-care
providers should advocate that coaches be trained to ensure that
young people compete safely and thrive physically, emotionally,
and socially (271). Health-care providers also should encourage
parents to be role models for their children, plan physical
activities that involve the whole family, and discuss with their
children the value of healthy behaviors such as physical activity
(117,231,239,258,269).

Recommendation 9. Community programs: Provide a range of
developmentally appropriate community sports and recreation
programs that are attractive to all young people.

Most physical activity among children and adolescents occurs
outside the school setting (129). Thus, community sports and
recreation programs are integral to promoting physical activity
among young people (3). These community programs can complement
the efforts of schools by providing children and adolescents
opportunities to engage in the types and levels of physical
activity that may not be offered in school. Community sports and
recreation programs also provide an avenue for reaching
out-of-school young people.

Provide a diversity of developmentally appropriate community
sports and recreation programs for all young people.

Young people become involved in structured physical activity
programs for various reasons: to develop competence, to build
social relationships, to enhance fitness, and to have fun
(145,272). However, adolescents' participation in community
sports and recreation programs declines with age (48,145). Many
young people drop out of these programs because the activities
are not fun, are too competitive, or demand too much time
(145,256). Because definitions of fun and success vary with each
person's age, sex, and skill level, community sports and
recreation programs should assess and try to meet the needs and
interests of all young people. These programs should also try to
match the skill level of the participants with challenges that
encourage skill development and fun and to develop programs that
are not based exclusively on winning (145,255).

Provide access to community sports and recreation programs for
young people.

In most communities, physical activity programs for young
people exist, but these opportunities often require
transportation, fees, or special equipment. These limitations
often discourage children and adolescents from low-income
families from participating. Communities should ensure that all
young people, irrespective of their family's income, have access
to these programs. For example, community sports and recreation
programs can collaborate with schools and other community
organizations (e.g., places of worship) to provide transportation
to these programs. Communities can also ask businesses to sponsor
youth physical activity programs and to provide children and
adolescents from low-income families appropriate equipment,
clothing, and footwear for participation in physical activity.

Evaluation can be used to assess and improve physical
activity policies, spaces and facilities, instruction, programs,
personnel training, health services, and student achievement. All
groups involved in and affected by school and community programs
to promote lifelong physical activity among young people should
have the opportunity to contribute to evaluation. Valid
evaluations may increase support for and involvement in these
programs by students, parents, teachers, and other school and
community personnel.

Evaluation is useful for gaining insight about the
implementation and quality of physical activity policies,
physical activity spaces and facilities, physical education and
health education curricula and instruction, extracurricular and
community sports and recreation programs, and pre-service and
in-service training programs for personnel. The Child and
Adolescent Trial for Cardiovascular Health (CATCH) (180) has
developed a model that can be used to assess the quantity and
quality of physical education instruction, lesson content,
fidelity of curriculum implementation, and opportunities for
other physical activity (273,274). National competency
frameworks, including Quality Sports, Quality Coaches: National
Standards for Athletic Coaches (213), National Standards for
Beginning Physical Education Teachers (265), A Guide for the
Development of Competency-Based Curricula for Entry Level Health
Educators (266), and Health Instruction Responsibilities and
Competencies for Elementary (K-6) Classroom Teachers (267) can be
used to assess the competencies of coaches, entry-level physical
education and health education teachers, and elementary school
teachers and the quality of professional training programs for
these people. Parents and guardians can use the checklist
developed by the National Association for Sport and Physical
Education to evaluate the quality of sports and physical activity
programs for their children (275). Other guidelines exist to
assess the provision of health services for children and
adolescents (231,258) and the safety of playgrounds (225,226).

Measuring students' achievement in physical education
requires a comprehensive assessment of their knowledge, motor and
behavioral skills, and behavior related to physical activity.
Measuring students' achievement in health education requires an
assessment of their knowledge, behavioral skills, and behaviors.
Moving into the Future: National Standards for Physical Education
(211) and National Health Education Standards: Achieving Health
Literacy (208) describe what students should know and be able to
do as a result of comprehensive physical education and health
education programs. Student's achievement may be measured using
paper-and-pencil tests that assess knowledge and performance
tests that assess motor and behavioral skills. Portfolios of
students' work that reflect their knowledge, motor and behavioral
skills, and progress toward personal physical activity goals are
appropriate for assessing students' achievement (276). Although
fitness testing is a common component of many school physical
education programs, the test results should not be used to assign
report card grades or assess program effectiveness (193,240,241).

CONCLUSION

School and community programs that promote regular physical
activity among young people could be among the most effective
strategies for reducing the public health burden of chronic
diseases associated with sedentary lifestyles. Programs that
provide students with the knowledge, attitudes, motor skills,
behavioral skills, and confidence to participate in physical
activity may establish active lifestyles among young people that
continue into and throughout their adult lives. These programs
can promote physical activity by establishing physical activity
policies; providing physical and social environments that enable
safe and enjoyable participation in physical activity;
implementing planned and sequential physical education and health
education curricula and instruction from kindergarten through
12th grade; providing extracurricular physical activity programs;
including parents and guardians in physical activity instruction
and programs; providing personnel training in methods to
effectively promote physical activity; providing health services
that encourage and support physical activity; providing
community-based sports and recreation programs; and evaluating
school and community physical activity instruction, programs, and
facilities.

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